Colorblind Devices, Longer-Wavelength Lasers Offer Safer Options for Darker Skin Tones: Ariella Kauvar, MD

For patients with darker skin tones, colorblind energy-based devices and longer-wavelength lasers are considered safest, according to Arielle Kauvar, MD, director of New York Laser & Skin Care and clinical professor of dermatology at NYU Grossman School of Medicine, in an interview at the Skin of Color Update 2025 in New York City.

She emphasizes that prevention strategies should include a thorough patient history and physical exam, assessing hyperpigmentation, sun exposure, and overall skin condition before treatment.

Watch part 1 to learn about common laser procedure complications in patients with skin of color and strategies to minimize them.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Which laser or energy-based technologies are currently the safest and most effective for darker skin tones?

There are a wide variety. Any of the colorblind energy devices are safe in skin of color, meaning they're not absorbed by pigment. There are many of them. There are radiofrequency devices: monopolar radiofrequency, bipolar radiofrequency, and radiofrequency microneedling. There are ultrasound treatments to lift and tighten skin. There is cryolipolysis, or CoolSculpting, which is also a colorblind treatment and is safe on skin of color. All of the devices that don't get absorbed, in particular, by melanin are going to be safe.

With regard to laser, what's important is to stay away from the short visible wavelengths, because melanin absorbs light in the entire visible spectrum, but it absorbs light more strongly in the green and yellow portions of the spectrum, meaning that a laser like a 532 nm, Q-switched, long-pulse, or picosecond laser is contraindicated.

Also, some of the vascular lasers are 595 nm, and you want to go to longer wavelengths. The safest wavelength in the visible to near-infrared spectrum is actually a 1064 nm Nd:YAG [neodymium-doped yttrium aluminum garnet] laser. There are YAG lasers available in different pulse durations for different targets.

How do you approach prevention strategies before initiating device-based treatments?

Well, the most important thing is to take a good history and physical exam. You want to know if a patient has a history of hyperpigmentation, melasma, or vitiligo, because those groups of patients are going to be at higher risk.

Also, a physical exam, so you want to look at them. They may not know what hyperpigmentation is. If individuals have hyperpigmentation, there are usually telltale marks on the skin. If they have acne, they're left with blemishes for a very long period of time; a scratch or a cut will also leave a blemish. When you do a physical exam, you look for those indications.

You also want to make sure the patient doesn't have an active suntan. You want to look at their exposed and non-exposed skin. Some people are chronically tan, so they have what we call bronzing because they're always in the sun. You need to both ask about that and look for signs, because people may not know, and that's extremely important.